Ketogenic Diet Reduces Sleep Anxiety in Children With Epilepsy


A total of 14 children and their mothers were evaluated in the study, and although improvements in sleep scores were also reported, they were not statistically significant.

Aycan Ünalp, MD, professor of pediatric neurology, Health Sciences University, Izmir Faculty of Medicine, Department of Pediatrics, Izmir, Turkey

Aycan Ünalp, MD

A study of children with drug-resistant epilepsy found that completing 3 months of Ketogenic diet therapy (KDT) significantly reduced sleep anxiety in children. Also included were patients’ mothers, with both groups seeing improvements in sleep scores, though these were not statistically significant. 

A total of 14 of the 24 children originally enrolled to begin KD treatment between January 2019 and January 2020 were included in the study. Male patients (n = 7) and female patients (n = 7) had an average age of 4.4 years, while their mothers had a mean age of 32.7 years.

Investigators utilized the Children’s Sleep Habits Questionnaire to evaluate sleep habits in children and the Pittsburgh Sleep Questionnaire for their mothers. Improvements in sleep quality were reported in 7 patients (50%), deterioration reported in 5 patients (37.5%), and no change in 2 patients (14.3%). All working mothers reported an improvement in sleep quality. Additionally, 7 patients (50%) reported having no seizures and 6 patients (42.9%) reported a 50% or greater reduction in seizure frequency. Of the 7 patients with improvement in sleep quality, 5 (71.4%) had full seizure control. 

“This study is the first study evaluating the sleep quality of mothers with drug-resistant children with epilepsy treated with KD. Few studies have been conducted on the sleep problems in children treated with KD for DRE,” lead author Aycan Ünalp, MD, professor of pediatric neurology, Health Sciences University, Izmir Faculty of Medicine, Department of Pediatrics, Izmir, Turkey, et al wrote. “These results suggest that seizure control and sleep disorders are inversely proportional. Despite the small number of working mothers, it was observed that sleep quality improved in all working mothers.”

When evaluating sleep scores, improvements were reported, but results were not statistically significant. Prior to KDT, mothers had a mean sleep score of 15.6 (standard deviation [SD], 3.1), and after KDT, the mean sleep score was 14.1 (SD, 2.9; P = .23). For children, the mean sleep score prior to KDT was 56.6 (SD, 7.3) and after KDT, mean sleep score was 47.7 (SD, 15.2; P = .054). Comparably, when looking at subscales of the questionnaire, after the third month of the KDT, children reported a significant decrease in sleep anxiety (P = .09). 

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Investigators further considered socioeconomic status of patients, finding that 2 patients with high socioeconomic status and 4 out of 7 patients with middle class socioeconomic status reported sleep improvement. Comparably, 4 out of 5 patients with low socioeconomic status reported a decrease in sleep quality. 

Discussing the observed adverse effect of low socioeconomic effect on sleep quality, Ünalp et al wrote, “We attributed this to the poor compliance of families with poor socioeconomic status to the KDT. While adequate sleep is an important factor in physical and mental health, research has shown that sleep duration can be affected by socioeconomic status. Low socioeconomic status has been associated with poor sleep, yet the mechanisms underlying this association are not well-understood.” 

Of the 10 patients who did not initiate KDT, 1 patient was excluded due to diagnosis with Sandhoff disease and inability to complete the third month control, 3 patients were excluded due to incompatibility, 3 patients were excluded when questionnaires were incomplete and consent forms could not be obtained from family members, 2 patients were not given third month questionnaires because they could not attend the control session, and 1 patient had been transferred to the intensive care unit and could not complete the questionnaire.

The study was limited due to the inability to evaluate the effect of antiepileptic drugs, as the sample size was small and multiple drugs were being used. The small sample further limited the calculation of descriptive statistics. The investigators noted that future studies should be larger with longer follow-up and pay attention to patient selection to initiate better sleep quality and increase diet compliance, investigators added. 

Ünalp A, Baysal BT, Saritas S, et al. Evalution of the effects of ketogenic diet therapy on sleep quality in children with drug-resistant epilepsy and their mothers. Epilepsy Behav. 2021;124:108327. doi:10.1016/j.yebeh.2021.108327
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